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Emery H, Matthews A, Duggan M. "A little bit of hope goes a long way": Exploring the role of peer workers in alcohol and other drug rehabilitation services. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024:209408. [PMID: 38763216 DOI: 10.1016/j.josat.2024.209408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/11/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Peer workers operating within health care settings can offer unique perspectives based on their own lived experience. Within alcohol and other drug (AOD) rehabilitation services, the potential value of peer work is becoming increasingly recognised. This qualitative study aimed to evaluate a newly implemented peer worker program located across three rehabilitation services in Tasmania, Australia. METHODS Online interviews were conducted with eight clients, seven peer workers, and five non-peer worker employees with varied experience with peer worker programs. All interviews were audio-recorded and transcribed verbatim. RESULTS Guided by an overarching exploratory-descriptive methodological framework, thematic analysis generated three overarching themes: 1) Enhancing and supporting client experiences (what peer workers did in their role to improve client experiences, 2) Changing experiences with AOD rehabilitation (the unique benefits and changes that peer work brings to AOD rehabilitation services) and 3) Finding organizational value (how defining peer work and the feasibility of the peer worker role was challenged by different organizational factors). Overall, peer work was viewed as a positive addition to all rehabilitation services that was able to enhance client experiences through various mechanisms, such as by sharing their own stories, assisting with understanding, and creating safety. Peer work was also able to create change in AOD services, by instilling hope and reducing stigma. However, ongoing challenges with defining the peer worker role in a way that offers organizational recognition and financial security remain. CONCLUSION Peer workers offer a unique and valuable perspective when working within rehabilitation services. Through their own lived experience peer workers were able to support clients and assist them in their recovery. These findings highlight the potential benefit of peer work programs within AOD rehabilitation services.
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Affiliation(s)
- Holly Emery
- School of Psychological Sciences, University of Tasmania, Launceston, Australia.
| | - Allison Matthews
- School of Psychological Sciences, University of Tasmania, Hobart, Australia.
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Englander H, Thakrar AP, Bagley SM, Rolley T, Dong K, Hyshka E. Caring for Hospitalized Adults With Opioid Use Disorder in the Era of Fentanyl: A Review. JAMA Intern Med 2024:2818022. [PMID: 38683591 DOI: 10.1001/jamainternmed.2023.7282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Importance The rise of fentanyl and other high-potency synthetic opioids across US and Canada has been associated with increasing hospitalizations and unprecedented overdose deaths. Hospitalization is a critical touchpoint to engage patients and offer life-saving opioid use disorder (OUD) care when admitted for OUD or other medical conditions. Observations Clinical best practices include managing acute withdrawal and pain, initiating medication for OUD, integrating harm reduction principles and practices, addressing in-hospital substance use, and supporting hospital-to-community care transitions. Fentanyl complicates hospital OUD care. Fentanyl's high potency intensifies pain, withdrawal, and cravings and increases the risk for overdose and other harms. Fentanyl's unique pharmacology has rendered traditional techniques for managing opioid withdrawal and initiating buprenorphine and methadone inadequate for some patients, necessitating novel strategies. Further, co-use of opioids with stimulants drugs is common, and the opioid supply is unpredictable and can be contaminated with benzodiazepines, xylazine, and other substances. To address these challenges, clinicians are increasingly relying on emerging practices, such as low-dose buprenorphine initiation with opioid continuation, rapid methadone titration, and the use of alternative opioid agonists. Hospitals must also reconsider conventional approaches to in-hospital substance use and expand clinicians' understanding and embrace of harm reduction, which is a philosophy and set of practical strategies that supports people who use drugs to be safer and healthier without judgment, coercion, or discrimination. Hospital-to-community care transitions should ensure uninterrupted access to OUD care after discharge, which requires special consideration and coordination. Finally, improving hospital-based addiction care requires dedicated infrastructure and expertise. Preparing hospitals across the US and Canada to deliver OUD best practices requires investments in clinical champions, staff education, leadership commitment, community partnerships, quality metrics, and financing. Conclusions and Relevance The findings of this review indicate that fentanyl creates increased urgency and new challenges for hospital OUD care. Hospital clinicians and systems have a central role in addressing the current drug crisis.
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Affiliation(s)
- Honora Englander
- Section of Addiction Medicine in General Internal Medicine and the Division of Hospital Medicine, Department of Medicine, Oregon Health and Science University, Portland
| | - Ashish P Thakrar
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sarah M Bagley
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | | | - Kathryn Dong
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Treitler P, Crystal S, Cantor J, Chakravarty S, Kline A, Morton C, Powell KG, Borys S, Cooperman NA. Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose. JAMA Netw Open 2024; 7:e243614. [PMID: 38526490 PMCID: PMC10964115 DOI: 10.1001/jamanetworkopen.2024.3614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/30/2024] [Indexed: 03/26/2024] Open
Abstract
Importance Patients treated in emergency departments (EDs) for opioid overdose often need drug treatment yet are rarely linked to services after discharge. Emergency department-based peer support is a promising approach for promoting treatment linkage, but evidence of its effectiveness is lacking. Objective To examine the association of the Opioid Overdose Recovery Program (OORP), an ED peer recovery support service, with postdischarge addiction treatment initiation, repeat overdose, and acute care utilization. Design, Setting, and Participants This intention-to-treat retrospective cohort study used 2014 to 2020 New Jersey Medicaid data for Medicaid enrollees aged 18 to 64 years who were treated for nonfatal opioid overdose from January 2015 to June 2020 at 70 New Jersey acute care hospitals. Data were analyzed from August 2022 to November 2023. Exposure Hospital OORP implementation. Main Outcomes and Measures The primary outcome was medication for opioid use disorder (MOUD) initiation within 60 days of discharge. Secondary outcomes included psychosocial treatment initiation, medically treated drug overdoses, and all-cause acute care visits after discharge. An event study design was used to compare 180-day outcomes between patients treated in OORP hospitals and those treated in non-OORP hospitals. Analyses adjusted for patient demographics, comorbidities, and prior service use and for community-level sociodemographics and drug treatment access. Results A total of 12 046 individuals were included in the study (62.0% male). Preimplementation outcome trends were similar for patients treated in OORP and non-OORP hospitals. Implementation of the OORP was associated with an increase of 0.034 (95% CI, 0.004-0.064) in the probability of 60-day MOUD initiation in the half-year after implementation, representing a 45% increase above the preimplementation mean probability of 0.075 (95% CI, 0.066-0.084). Program implementation was associated with fewer repeat medically treated overdoses 4 half-years (-0.086; 95% CI, -0.154 to -0.018) and 5 half-years (-0.106; 95% CI, -0.184 to -0.028) after implementation. Results differed slightly depending on the reference period used, and hospital-specific models showed substantial heterogeneity in program outcomes across facilities. Conclusions and Relevance In this cohort study of patients treated for opioid overdose, OORP implementation was associated with an increase in MOUD initiation and a decrease in repeat medically treated overdoses. The large variation in outcomes across hospitals suggests that treatment effects were heterogeneous and may depend on factors such as implementation success, program embeddedness, and availability of other hospital- and community-based OUD services.
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Affiliation(s)
- Peter Treitler
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
- Boston University School of Social Work, Boston, Massachusetts
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
- School of Social Work, Rutgers University, New Brunswick, New Jersey
- School of Public Health, Rutgers University, Piscataway, New Jersey
| | - Joel Cantor
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Sujoy Chakravarty
- Department of Health Sciences, Rutgers University, Camden, New Jersey
| | - Anna Kline
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Cory Morton
- School of Social Work, Rutgers University, New Brunswick, New Jersey
- Center for Prevention Science, Rutgers University, New Brunswick, New Jersey
- Northeast and Caribbean Prevention Technology Transfer Center, Rutgers University, New Brunswick, New Jersey
| | - Kristen Gilmore Powell
- School of Social Work, Rutgers University, New Brunswick, New Jersey
- Center for Prevention Science, Rutgers University, New Brunswick, New Jersey
- Northeast and Caribbean Prevention Technology Transfer Center, Rutgers University, New Brunswick, New Jersey
| | - Suzanne Borys
- Division of Mental Health and Addiction Services, New Jersey Department of Human Services, Trenton
| | - Nina A. Cooperman
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
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Lindsay AR, Winkelman TNA, Bart G, Rhodes MT, Shearer RD. Hospital Addiction Medicine Consultation Service Orders and Outcomes by Patient Race and Ethnicity in an Urban, Safety-Net Hospital. J Gen Intern Med 2024; 39:168-175. [PMID: 37552419 PMCID: PMC10853106 DOI: 10.1007/s11606-023-08356-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Hospital admissions involving substance use disorders are increasing and represent an opportunity to engage patients in substance use treatment. Addiction medicine consultation services improve access to medications for opioid use disorder (MOUD) and patient outcomes. However, as hospitals continue to adopt addiction medicine consultation services it is important to identify where disparities may emerge in the process of care. OBJECTIVE To describe addiction medicine consultation service use by race and ethnicity as well as substance to identify opportunities to reduce substance use treatment disparities. DESIGN Retrospective cohort study using 2016-2021 Electronic Health Record data from a large Midwest safety-net hospital. PARTICIPANTS Hospitalized adults aged 18 or older, with one or more substance use disorders. MAIN MEASURES Consultation orders placed, patient seen by consult provider, and receipt of MOUD by self-reported race. KEY RESULTS Between 2016 and 2021, we identified 16,895 hospitalized patients with a substance use disorder. Consultation orders were placed for 6344 patients and 2789 were seen by the consult provider. Black patients were less likely (aOR = 0.58; 95% CI: 0.53-0.63) to have an addiction medicine consultation order placed and, among patients with a consultation order, were less likely (aOR = 0.74; 95% CI: 0.65-0.85) to be seen by the consult provider than White patients. Overall, Black patients with OUD were also less likely to receive MOUD in the hospital (aOR = 0.63; 95% CI: 0.50-0.79) compared to White patients. However, there were no differences in MOUD receipt among Black and White patients seen by the consult provider. CONCLUSIONS Using Electronic Health Record data, we identified racial and ethnic disparities at multiple points in the inpatient addiction medicine consultation process. Addressing these disparities may support more equitable access to MOUD and other substance use treatment in the hospital setting.
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Affiliation(s)
- Amber R Lindsay
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Tyler N A Winkelman
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Gavin Bart
- Division of Addiction Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Michael T Rhodes
- Division of Hospital Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Riley D Shearer
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.
- Division of Health Policy and Management, School of Public Health, University of Minnesota Medical School, 420 Delaware St. Minneapolis, Minneapolis, DE, 55455, USA.
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Kim S, Lee I, Lee M, Champion JD. The effects and challenges of alcohol use disorder peer support service in South Korea: A focus group study. Int J Ment Health Nurs 2024; 33:159-165. [PMID: 37743562 DOI: 10.1111/inm.13230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
Although alcohol use disorder (AUD) is associated with a high disease burden due to medical consequences, people with AUD often do not receive appropriate treatment or community health service support. Peer-support services, intended to bridge the gap between patients with AUD and mental health providers have produced successful results. However, the number of studies on peer supporters in South Korea, especially those with AUD, is limited. Therefore, research on the effectiveness or challenges faced by AUD peer supporters in Korea is required to meet the challenges posed by increases in the numbers and capabilities of peer supporters in the mental health field. This qualitative study (N = 13), included focus group interviews of AUD peer supporters (n = 7), and supervisors of peer supporters (n = 6). Focus group data were analysed using thematic analysis methods. These analyses identified themes including 'Life before AUD peer supporters: The moment of change', 'Effects of peer support services: Working as peer supporters changed our lives', 'Challenges of peer supporter services: Things experienced as a team' and 'Future directions: How we can improve peer support services'? Findings indicate that healthcare professionals, educated to maintain clear boundaries, are discouraged from disclosing personal information or developing personal relationships with patients. On the other hand, peer supporters discuss personal histories and prioritize personal connections. By acting as comrades, peer supporters have positive effects. By sharing their experiences, peer supporters formed appropriate relationships with AUD patients and families resulting in more active engagement in treatment programmes and increased numbers of patients receiving outpatient treatment.
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Affiliation(s)
- Soojeong Kim
- Department of Nursing, College of Medicine, Inha University, Incheon, South Korea
| | - Insuk Lee
- Department of Nursing, College of Medicine, Inha University, Incheon, South Korea
| | - Mihyong Lee
- Department of Nursing, College of Medicine, Inha University, Incheon, South Korea
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O'Neill M, Michalski C, Hayman K, Hulme J, Dube S, Diemert LM, Kornas K, Schoffel A, Rosella LC, Boozary A. "Whatever journey you want to take, I'll support you through": a mixed methods evaluation of a peer worker program in the hospital emergency department. BMC Health Serv Res 2024; 24:147. [PMID: 38287378 PMCID: PMC10826204 DOI: 10.1186/s12913-023-10532-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 12/27/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND People who are unhoused, use substances (drugs and/or alcohol), and who have mental health conditions experience barriers to care access and are frequently confronted with discrimination and stigma in health care settings. The role of Peer Workers in addressing these gaps in a hospital-based context is not well characterized. The aim of this evaluation was to 1) outline the role of Peer Workers in the care of a marginalized populations in the emergency department; 2) characterize the impact of Peer Workers on patient care, and 3) to describe how being employed as a Peer Worker impacts the Peer. METHODS Through a concurrent mixed methods evaluation, we explore the role of Peer Workers in the care of marginalized populations in the emergency department at two urban hospitals in Toronto, Ontario Canada. We describe the demographic characteristics of patients (n = 555) and the type of supports provided to patients collected through a survey between February and June 2022. Semi-structured, in-depth interviews were completed with Peer Workers (n = 7). Interviews were thematically analyzed using a deductive approach, complemented by an inductive approach to allow new themes to emerge from the data. RESULTS Support provided to patients primarily consisted of friendly conversations (91.4%), discharge planning (59.6%), tactics to help the patient navigate their emotions/mental wellbeing (57.8%) and sharing their lived experience (50.1%). In over one third (38.9%) of all patient interactions, Peer Workers shared new information about the patient with the health care team (e.g., obtaining patient identification). Five major themes emerged from our interviews with Peer Workers which include: (1) Establishing empathy and building trust between the patient and their care team through self-disclosure; (2) Facilitating a person-centered approach to patient care through trauma-informed listening and accessible language; (3) Support for patient preferences on harm reduction; (4) Peer worker role facilitating self-acceptance and self-defined recovery; and (5) Importance of supports and resources to help Peer Workers navigate the emotional intensity of the emergency department. CONCLUSIONS The findings add to the literature on Peer Worker programs and how such interventions are designed to best meet the needs of marginalized populations.
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Affiliation(s)
- Meghan O'Neill
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Camilla Michalski
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kate Hayman
- University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer Hulme
- University Health Network, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sané Dube
- University Health Network, Toronto, ON, Canada
- Gattuso Centre for Social Medicine and Population Health, University Health Network, Toronto, ON, Canada
| | - Lori M Diemert
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kathy Kornas
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alice Schoffel
- University Health Network, Toronto, ON, Canada
- Gattuso Centre for Social Medicine and Population Health, University Health Network, Toronto, ON, Canada
| | - Laura C Rosella
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Andrew Boozary
- University Health Network, Toronto, ON, Canada.
- Gattuso Centre for Social Medicine and Population Health, University Health Network, Toronto, ON, Canada.
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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Paradise RK, Wakeman SE. Recruiting and Retaining a Diverse and Skilled Addiction Treatment Workforce. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:10-15. [PMID: 38258849 DOI: 10.1177/29767342231210210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
National drug overdose deaths have been rising for decades, with particularly significant increases in recent years among populations of color. There is an urgent need for timely, accessible substance use disorder treatment, but workforce shortages across roles and settings impede the ability of the treatment system to meet the rising and evolving demand. In this Commentary, the authors discuss reasons for workforce shortages across roles, and offer recommendations for 8 areas of investment to grow and sustain a substance use and addiction care workforce prepared to address the overdose crisis in a racially equitable manner.
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Affiliation(s)
| | - Sarah E Wakeman
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Chen Y, Yuan Y, Reed BG. Experiences of peer work in drug use service settings: A systematic review of qualitative evidence. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104182. [PMID: 37683570 DOI: 10.1016/j.drugpo.2023.104182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/14/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND People with lived or living experiences of drug use and services have been increasingly incorporated into nonpeer-led mainstream organizational settings as a unique workforce. Despite the much discussed effectiveness of peer services in achieving measurable outcomes, limited attention has been given to the experiential aspects of peer work from the perspectives of peers, clients, or others involved. This systematic review synthesized qualitative evidence examining the experiences of peer work in nonpeer-led drug use service settings. It focused on the benefits of incorporating peers as a unique workforce, the challenges they face, and the organizational factors that influence their practices. METHODS A search of 15 databases identified 3,940 unique citations, 33 of which met inclusion criteria. Thematic analysis was utilized to synthesize their findings. RESULTS Foregrounding the uniqueness of peers' shared experience, studies have shown that incorporating peers into nonpeer-led settings can provide benefits at the client, organizational, and societal levels while promoting peers' personal and professional growth. The unique shared experience of peers can also present multidimensional challenges, such as triggering, boundary negotiation, and feelings of being trapped by their peer identity. To fully integrate peers into the system, organizations need to work with them to reconstruct organizational mission, culture, and structures in a way that recognizes and genuine commits to peers' unique values. CONCLUSION This review highlights the significance of understanding peer uniqueness for organizations to create nourishing conditions for peer services and calls for future research exploring context- and setting-specific peer roles and organizational enablers and barriers.
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Affiliation(s)
- Yun Chen
- School of Social Work, University of Michigan, 1080 S. University Avenue, Ann Arbor, MI, 48109, United States.
| | - Yeqing Yuan
- School of Social Work, College of Health, University of Alaska Anchorage, UAA Professional Studies Building, 2533 Providence Dr, Suite 234, Anchorage, AK 99508, United States
| | - Beth Glover Reed
- School of Social Work, University of Michigan, 1080 S. University Avenue, Ann Arbor, MI, 48109, United States
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Turuba R, Toddington C, Tymoschuk M, Amarasekera A, Howard AM, Brockmann V, Tallon C, Irving S, Mathias S, Henderson JL, Barbic S. "A peer support worker can really be there supporting the youth throughout the whole process": a qualitative study exploring the role of peer support in providing substance use services to youth. Harm Reduct J 2023; 20:118. [PMID: 37644488 PMCID: PMC10463579 DOI: 10.1186/s12954-023-00853-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Youth (ages 12-24) rarely access services and supports to address substance use concerns. Peer support can facilitate service engagement and has been associated with positive substance use recovery outcomes in adults, yet few studies have examined this role among youth specifically. As such, this qualitative study explored the role of peer support in providing substance use services to youth in British Columbia and how best to support them in their role. METHODS Participatory action research methods were used by partnering with youth who had lived/living experience of substance use, including peer support workers, to co-design the research protocol and materials. An initial focus group and subsequent interviews were held with 18 peer support workers who provide services to youth (ages 12-24) based on their own lived experience with mental health and/or substance use. The discussions were audio-recorded, transcribed verbatim, and analysed thematically using an inductive approach. RESULTS Peer support workers' core experiences providing substance use services to youth centred around supporting youth throughout the whole process. This was accomplished by meeting youth where they are at, providing individualized care, and bridging the gap between other services and supports. However, participants experienced multiple organizational barriers hindering their ability to support youth and stressed the importance of having an employer who understands the work you are doing. This involved having someone advocating for the peer support role to promote collaboration, empowering peers to set boundaries and define their own role, and providing adequate training and mentorship. Finally, peer support workers described how their lived experience bridges connection and de-stigmatization at the individual, organizational, and community level, which was unique to their role. CONCLUSIONS Peer support plays a unique role in youths' substance use journeys, given their own lived experience and flexibility within their role. However, their position is often misunderstood by employers and other service providers, leaving peers with inadequate support, training, and mentorship to do their job. The findings from this study call for improved integration of peer support into service environments, as well as standardized training that is in-depth and continuous.
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Affiliation(s)
- Roxanne Turuba
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Providence Health Care, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
- Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Ciara Toddington
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Providence Health Care, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Miranda Tymoschuk
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Providence Health Care, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Anurada Amarasekera
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Providence Health Care, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Amanda Madeleine Howard
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Providence Health Care, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Violet Brockmann
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Providence Health Care, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Corinne Tallon
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Providence Health Care, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Sarah Irving
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Providence Health Care, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Steve Mathias
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Providence Health Care, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Providence Research, 1190 Hornby Street, 10th Floor, Vancouver, BC, V6Z 2K5, Canada
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - J L Henderson
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8Th Floor, Toronto, ON, M5T 1R8, Canada
- Youth Wellness Hubs Ontario, 80 Workman Way, Toronto, ON, M4J 1H4, Canada
| | - Skye Barbic
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Providence Health Care, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Providence Research, 1190 Hornby Street, 10th Floor, Vancouver, BC, V6Z 2K5, Canada
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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Collins AB, Baird J, Nimaja E, Ashenafi Y, Clark MA, Beaudoin FL. Experiences of patients at high risk of opioid overdose accessing emergency department and behavioral health interventions: a qualitative analysis in an urban emergency department. BMC Health Serv Res 2023; 23:370. [PMID: 37069593 PMCID: PMC10110343 DOI: 10.1186/s12913-023-09387-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/11/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Emergency Departments (EDs) have become critical 'touchpoints' for the identification and early engagement of patients at risk of overdose or who have an opioid use disorder (OUD). Our objectives were to examine patients' ED experiences, identify barriers and facilitators of service uptake in ED settings, and explore patients' experiences with ED staff. METHODS This qualitative study was part of a randomized controlled trial that evaluated the effectiveness of clinical social workers and certified peer recovery specialists in increasing treatment uptake and reducing opioid overdose rates for people with OUD. Between September 2019 and March 2020, semi-structured interviews were conducted 19 participants from the trial. Interviews sought to assess participants' ED care experiences across intervention type (i.e., clinical social worker or peer recovery specialist). Participants were purposively sampled across intervention arm (social work, n = 11; peer recovery specialist, n = 7; control, n = 1). Data were analyzed thematically with a focus on participant experiences in the ED and social and structural factors shaping care experiences and service utilization. RESULTS Participants reported varied ED experiences, including instances of discrimination and stigma due to their substance use. However, participants underscored the need for increased engagement of people with lived experience in ED settings, including the use of peer recovery specialists. Participants highlighted that ED provider interactions were critical drivers of shaping care and service utilization and needed to be improved across EDs to improve post-overdose care. CONCLUSIONS While the ED provides an opportunity to reach patients at risk of overdose, our results demonstrate how ED-based interactions and service provision can impact ED care engagement and service utilization. Modifications to care delivery may improve experiences for patients with OUD or at high risk for overdose. TRIAL REGISTRATION Clinical trial registration: NCT03684681.
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Affiliation(s)
- Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, 121 S Main Street, Providence, RI, USA
| | - Janette Baird
- Department of Emergency Medicine, Warrant Alpert Medical School of Brown University, 55 Claverick Street 2Nd Floor, Providence, RI, 02903, USA
| | - Evelyn Nimaja
- Department of Emergency Medicine, Warrant Alpert Medical School of Brown University, 55 Claverick Street 2Nd Floor, Providence, RI, 02903, USA
| | - Yokabed Ashenafi
- Department of Epidemiology, Brown University School of Public Health, 121 S Main Street, Providence, RI, USA
| | - Melissa A Clark
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University School of Public Health, 121 S Main Street, Providence, RI, USA.
- Department of Emergency Medicine, Warrant Alpert Medical School of Brown University, 55 Claverick Street 2Nd Floor, Providence, RI, 02903, USA.
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11
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Wang J, Claman A, Singh S, Sidelnik SA, Arshed A. Best Practices in Substance Use Disorders to Achieve Treatment Equity in Consultation-Liaison Psychiatry. Psychiatr Ann 2023. [DOI: 10.3928/00485713-20230103-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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12
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Ibrahim N, Selim A, Ng F, Kasaby M, Ali AM, Eweida R, Almakki D, Elaagib A, Slade M. Experiences of peer support workers supporting individuals with substance use disorders in Egypt: phenomenological analysis. BMC Health Serv Res 2022; 22:1012. [PMID: 35941645 PMCID: PMC9361559 DOI: 10.1186/s12913-022-08393-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background Peer support work for substance use disorders is widely implemented in high-income countries. More research is still needed to understand its applicability in settings which have proportionately low budgets allocated to mental health. Peer Support Workers are individuals who managed to achieve recovery from substance use disorders and help people remain engaged in their recovery and prevent relapse through shared understanding. Aim To investigate the experience of peer support workers providing recovery support to people with substance use disorders in Egypt. Methods A qualitative phenomenological design was used in which 17 adults working as peer support workers for substance use disorders were recruited by means of purposive and snowball sampling. A semi-structured interview with participants was conducted by phone or video-call. Interviews were transcribed and thematically analysed based on descriptive phenomenology. Results Three superordinate themes were identified: role responsibility, Peer Support Workers’ need for organizational and stakeholders’ support, and challenges to the role integrity. Conclusion and recommendations The findings indicate the need for national and governmental support to peer support workers engaged with people with substance use disorders in Egypt and educating families and the public about the role of peer support workers in substance use disorders.
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Affiliation(s)
- Nashwa Ibrahim
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt.
| | - Abeer Selim
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt.,College of Nursing, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Muhamed Kasaby
- Center for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, 21527, Egypt
| | - Rasha Eweida
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, 21527, Egypt
| | | | | | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK.,Nord University, Postboks 474, 7801, Namsos, Norway
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13
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A Taxonomy of Hospital-Based Addiction Care Models: a Scoping Review and Key Informant Interviews. J Gen Intern Med 2022; 37:2821-2833. [PMID: 35534663 PMCID: PMC9411356 DOI: 10.1007/s11606-022-07618-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/12/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is pressing need to improve hospital-based addiction care. Various models for integrating substance use disorder care into hospital settings exist, but there is no framework for describing, selecting, or comparing models. We sought to fill that gap by constructing a taxonomy of hospital-based addiction care models based on scoping literature review and key informant interviews. METHODS Methods included a scoping review of the literature on US hospital-based addiction care models and interventions for adults, published between January 2000 and July 2021. We conducted semi-structured interviews with 15 key informants experienced in leading, implementing, evaluating, andpracticing hospital-based addiction care to explore model characteristics, including their perceived strengths, limitations, and implementation considerations. We synthesized findings from the literature review and interviews to construct a taxonomy of model types. RESULTS Searches identified 2,849 unique abstracts. Of these, we reviewed 280 full text articles, of which 76 were included in the final review. We added 8 references from reference lists and informant interviews, and 4 gray literature sources. We identified six distinct hospital-based addiction care models. Those classified as addiction consult models include (1) interprofessional addiction consult services, (2) psychiatry consult liaison services, and (3) individual consultant models. Those classified as practice-based models, wherein general hospital staff integrate addiction care into usual practice, include (4) hospital-based opioid treatment and (5) hospital-based alcohol treatment. The final type was (6) community-based in-reach, wherein community providers deliver care. Models vary in their target patient population, staffing, and core clinical and systems change activities. Limitations include that some models have overlapping characteristics and variable ways of delivering core components. DISCUSSION A taxonomy provides hospital clinicians and administrators, researchers, and policy-makers with a framework to describe, compare, and select models for implementing hospital-based addiction care and measure outcomes.
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14
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Chockalingam L, Burnham EL, Jolley SE. Medication prescribing for alcohol use disorders during alcohol-related encounters in a Colorado regional healthcare system. Alcohol Clin Exp Res 2022; 46:1094-1102. [PMID: 35723682 DOI: 10.1111/acer.14837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Abstract
RATIONALE Investigations show that medications for alcohol use disorders (MAUD) reduce heavy drinking and relapses. However, only 1.6% of individuals with alcohol use disorders (AUD) receive MAUD across care settings. The epidemiology of MAUD prescribing in the acute care setting is incompletely described. We hypothesized that MAUD would be under prescribed in inpatient acute care hospital settings compared to the outpatient, emergency department (ED), and inpatient substance use treatment settings. METHODS We evaluated electronic health record (EHR) data from adult patients with an International Classification of Diseases, 10th revision (ICD-10) alcohol-related diagnosis in the University of Colorado Health (UCHealth) system between January 1, 2016 and 31 December, 2019. Data from patients with an ICD-10 diagnosis code for opioid use disorder and those receiving MAUD prior to their first alcohol-related episode were excluded. The primary outcome was prescribing of MAUD, defined by prescription of naltrexone, acamprosate, and/or disulfiram. We performed bivariate and multivariate analyses to identify independent predictors of MAUD prescribing at UCHealth. RESULTS We identified 48,421 unique patients with 136,205 alcohol-related encounters at UCHealth. Encounters occurred in the ED (42%), inpatient acute care (17%), inpatient substance use treatment (18%), or outpatient primary care (12%) settings. Only 2270 (5%) patients received MAUD across all settings. Female sex and addiction medicine consults positively predicted MAUD prescribing. In contrast, encounters outside inpatient substance use treatment, Hispanic ethnicity, and black or non-white race were negative predictors of MAUD prescribing. Compared to inpatient substance use treatment, inpatient acute care hospitalizations for AUD was associated with a 93% reduced odds of receiving MAUD. CONCLUSIONS AUD-related ED and inpatient acute care hospital encounters in our healthcare system were common. Nevertheless, prescriptions for MAUD were infrequent in this population, particularly in inpatient settings. Our findings suggest that the initiation of MAUD for patients with alcohol-related diagnoses in acute care settings deserves additional evaluation.
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Affiliation(s)
| | - Ellen L Burnham
- Department of Medicine, Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, Colorado, USA
| | - Sarah E Jolley
- Department of Medicine, Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, Colorado, USA
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The Development and Implementation of a Hospitalist-Directed Addiction Medicine Consultation Service to Address a Treatment Gap. J Gen Intern Med 2022; 37:1065-1072. [PMID: 34013473 PMCID: PMC8971245 DOI: 10.1007/s11606-021-06849-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Hospitalizations related to the consequences of substance use are rising yet most hospitalized patients with substance use disorder do not receive evidence-based addiction treatment. Opportunities to leverage the hospitalist workforce could close this treatment gap. AIM To describe the development, implementation, and evaluation of a hospitalist-directed addiction consultation service (ACS) to provide in-hospital addiction treatment. SETTING Six hundred fifty-bed university hospital in Aurora, Colorado. PROGRAM DESCRIPTION Hospitalists completed buprenorphine waiver training, participated in a 13-part addiction lecture series, and completed a minimum of 40 hours of online addiction training. Hospitalists participated in shadow shifts with an addiction-trained physician. Dedicated addiction social workers developed relationships with local addiction treatment services. PROGRAM EVALUATION METRICS Physician-related metrics included education, training, and clinical time spent in addiction practice. Patient and encounter-related metrics included a description of ACS care provision. RESULTS Eleven hospitalists completed an average of 95 hours of addiction-related didactics. Once addiction training was complete, hospitalists spent an average of 30 days over 12 months staffing a weekday ACS. Between October 2019 and November 2020, the ACS completed 1620 consultations on 1350 unique patients. Alcohol was the most common substance (n = 1279; 79%), followed by tobacco (979; 60.4%), methamphetamines/amphetamines (n = 494; 30.5%), and opioids (n = 400; 24.7%). Naltrexone was the most frequently prescribed medication (n = 350; 21.6%), followed by acamprosate (n = 93; 5.7%), and buprenorphine (n = 77, 4.8%). Trauma was a frequent discharge diagnoses (n = 1564; 96.5%). Leaving prior to treatment completion was commonly noted (n = 120, 7.4%). The ACS completed 47 in-hospital methadone enrollments. DISCUSSION The hospitalist-directed ACS is a promising clinical initiative that could be implemented to expand hospital-based addiction treatment. Future research is needed to understand challenges to disseminating this model into other hospital settings, and to evaluate intended and unintended effects of broad implementation.
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Kauffman E, Qiu Y, Frey JA, Bischof JJ. Barriers and Facilitators to Peer Support Services for Patients With Opioid Use Disorder in the Emergency Department. Cureus 2022; 14:e23145. [PMID: 35444910 PMCID: PMC9009995 DOI: 10.7759/cureus.23145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 12/02/2022] Open
Abstract
There is a high prevalence of opioid use disorder in the United States, and emergency departments (EDs) play multiple vital roles in providing care to help these patients with achieving sobriety, one of which is the application of peer recovery services. This technical report discusses the utilization of peer recovery supporters in the ED and associated barriers. They include but are not limited to the difficult hiring process, referral process challenges for certain populations, difficulty with follow-up data collection, retention of peer recovery supporters, and a lack of ED provider awareness. This article also discussed strategies to address these barriers. Examples include simplifying hospital onboarding processes for peer recovery supporters, obtaining grants to utilize peer recovery services, and using managed care organizations to facilitate follow-up data collection, ED provider education, and discharge planning.
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Button D, Hartley J, Robbins J, Levander XA, Smith NJ, Englander H. Low-dose Buprenorphine Initiation in Hospitalized Adults With Opioid Use Disorder: A Retrospective Cohort Analysis. J Addict Med 2022; 16:e105-e111. [PMID: 34001775 PMCID: PMC8595358 DOI: 10.1097/adm.0000000000000864] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Patients with opioid use disorder (OUD) can initiate buprenorphine without requiring a withdrawal period through a low-dose (sometimes referred to as "micro-induction") approach. Although there is growing interest in low-dose buprenorphine initiation, current evidence is limited to case reports and small case series. METHODS We performed a retrospective cohort study of patients with OUD seen by a hospital-based addiction medicine consult service who underwent low-dose buprenorphine initiation starting during hospital admission. We then integrated our practice-based experiences with results from the existing literature to create practice considerations. RESULTS Sixty-eight individuals underwent 72 low-dose buprenorphine initiations between July 2019 and July 2020. Reasons for low-dose versus standard buprenorphine initiation included co-occurring pain (91.7%), patient anxiety around the possibility of withdrawal (69.4%), history of precipitated withdrawal (9.7%), opioid withdrawal intolerance (6.9%), and other reason/not specified (18.1%). Of the 72 low-dose buprenorphine initiations, 50 (69.4%) were completed in the hospital, 9 (12.5%) transitioned to complete as an outpatient, and 13 (18.1%) were terminated early. We apply our experiences and findings from literature to recommendations for varied clinical scenarios, including acute illness, co-occurring pain, opioid withdrawal intolerance, transition from high dose methadone to buprenorphine, history of precipitated withdrawal, and rapid hospital discharge. We share a standard low-dose initiation protocol with potential modifications based on above scenarios. CONCLUSIONS Low-dose buprenorphine initiation offers a well-tolerated and versatile approach for hospitalized patients with OUD. We share lessons from our experiences and the literature, and provide practical considerations for providers.
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Affiliation(s)
- Dana Button
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University
| | | | - Jonathan Robbins
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University
| | - Ximena A. Levander
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University
| | - Natashia J. Smith
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University
| | - Honora Englander
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University
- Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University
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Viking T, Wenzer J, Hylin U, Nilsson L. Peer support workers’ role and expertise and interprofessional learning in mental health care: a scoping review. J Interprof Care 2022; 36:828-838. [PMID: 35129027 DOI: 10.1080/13561820.2021.2014796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- T. Viking
- University West, Trollhättan, Sweden
| | - J. Wenzer
- University of Gothenburg, Gothenburg, Sweden
| | - U. Hylin
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
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Trust in Hospital Physicians Among Patients With Substance Use Disorder Referred to an Addiction Consult Service: A Mixed-methods Study. J Addict Med 2022; 16:41-48. [PMID: 33577229 PMCID: PMC8349928 DOI: 10.1097/adm.0000000000000819] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Trust is essential in patient-physician relationships. Hospitalized patients with substance use disorders (SUDs) often experience stigma and trauma in the hospital, which can impede trust. Little research has explored the role of hospital-based addictions care in creating trusting relationships with patients with SUDs. This study describes how trust in physicians changed among hospitalized people with SUDs who were seen by an interprofessional addiction medicine service. METHODS We analyzed data from hospitalized patients with SUD seen by an addiction consult service from 2015 to 2018. Participants completed surveys at baseline and 30 to 90 days after hospital discharge. Follow-up assessments included open-ended questions exploring participant experiences with hospitalization and the addiction consult service. We measured provider trust using the Wake Forest Trust scale. We modeled trust trajectories using discrete mixture modeling, and sampled qualitative interviews from those trust trajectories. RESULTS Of 328 participants with SUD who had prior hospitalizations but had not previously been seen by an addiction consult service, 196 (59.8%) had both baseline and follow-up trust scores. We identified 3 groups of patients: Persistent-Low Trust, Increasing Trust, and Persistent-High Trust and 4 qualitative themes around in-hospital trust: humanizing care, demonstrating addiction expertise, reliability, and granting agency. CONCLUSIONS Most participants retained or increased to high trust levels after hospitalization with an addiction consult service. Addiction consult services can create environments where healthcare providers build trust with, and humanize care for, hospitalized patients with SUD, and can also mitigate power struggles that hospitalized patients with SUD frequently experience.
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20
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Peer Recovery Support Services Across the Continuum: In Community, Hospital, Corrections, and Treatment and Recovery Agency Settings - A Narrative Review. J Addict Med 2022; 16:93-100. [PMID: 33560695 PMCID: PMC8339174 DOI: 10.1097/adm.0000000000000810] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In this narrative review, we outline the literature describing the history, training, certification, and role of peer recovery support specialists working with people with substance use disorders at different stages of active use and recovery. We explore the impact of peer recovery support specialists serving people in various settings, including the community, hospitals and emergency departments, jails and prisons, and treatment and recovery agencies; and describes considerations for future expansion of peer recovery support services, including supervision needs, compassion fatigue and burnout, and scope of practice. Finally, we make recommendations to support the broad implementation of peer recovery support services as a sustainable, cohesive, and replicable component of harm reduction and addiction services. We also make recommendations for research to continue to evaluate peer recovery support specialist interventions across settings and outcomes.
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Brady LA, Wozniak ML, Brimmer MJ, Terranova E, Moore C, Kahn L, Vest BM, Thomas M. Coping Strategies and Workplace Supports for Peers with Substance Use Disorders. Subst Use Misuse 2022; 57:1772-1778. [PMID: 36017896 DOI: 10.1080/10826084.2022.2112228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Introduction: Substance use disorder (SUD) peers provide support and navigation through a fragmented treatment system for people who use drugs (PWUD) and those in recovery. While barriers to peers' work are well established, from role ambiguity to stigma surrounding substance use, little research has focused on factors that facilitate peers' work. Methods: We conducted in-depth semi-structured interviews (N=20) with peers as part of an evaluation of a larger project related to the opioid crisis in Western New York. Participants were recruited from a regional peer network via flyers, emails, and a brief presentation. Interviews were conducted in person or by phone, audio recorded, and transcribed. Transcripts were analyzed using thematic content analysis. Results: Peers emphasized two factors: healthy personal coping strategies and strong workplace supports. Coping strategies included a sense of community, setting appropriate boundaries, and self-care routines. At the workplace, peers valued mental and emotional support, as well as professional relationships and organizational policies that made their work easier and supported self-care. For a few peers, professional relationships included advocating on behalf of PWUD by sharing personal experiences of SUD. Conclusions: Peers valued peer colleagues and peer-led organizations, noting how shared experiences of substance use and recovery enabled a unique support system. For peers who lack such support at work, the authors suggest peer networks as an alternative. We also recommend organizational policies and practices to facilitate peers' work, such as promoting peer input and feedback, but further research is needed to measure effects on peer retention and job satisfaction.
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Affiliation(s)
- Laura A Brady
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
| | - M L Wozniak
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
| | - M J Brimmer
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
| | - E Terranova
- Erie County Department of Health, Buffalo, NY, USA
| | - C Moore
- Erie County Department of Health, Buffalo, NY, USA
| | - L Kahn
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
| | - B M Vest
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
| | - M Thomas
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
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Patel E, Solomon K, Saleem H, Saloner B, Pugh T, Hulsey E, Leontsini E. Implementation of buprenorphine initiation and warm handoff protocols in emergency departments: A qualitative study of Pennsylvania hospitals. J Subst Abuse Treat 2021; 136:108658. [PMID: 34774397 DOI: 10.1016/j.jsat.2021.108658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/18/2021] [Accepted: 11/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Emergency departments (ED) are a critical touchpoint for patients with opioid use disorder (OUD). In 2019, Pennsylvania had the fifth highest drug overdose mortality rate in the United States. State efforts have focused on implementing evidence-based ED care protocols, including induction of buprenorphine and warm handoffs to community treatment. OBJECTIVE We examined hospital staff's perspectives on the processes, challenges, and facilitators to buprenorphine initiation and warm handoff protocols in the ED. METHODS We used a qualitative case study design to focus on six Pennsylvania hospitals. The study selected hospitals using purposive sampling to capture varying hospital size, rurality, teaching status, and phase of protocol implementation. The study staff interviewed hospital staff with key roles in OUD care delivery in the ED, which included administrators, physicians, nurses, recovery support professionals, care coordinators, a social worker, and a pharmacist. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured virtual interviews with 21 key informants from June to November 2020. Interviews were transcribed, deductively coded, and analyzed using CFIR domains and constructs to summarize factors influencing implementation of OUD ED care protocols and warm handoff to care protocols, as well as suggestions that emerged between and across cases. RESULTS Despite variation in the local context between hospitals, we identified common themes that influenced buprenorphine and warm handoffs across sites. Attention to hospital OUD care through state-level initiatives like the Hospital Quality Improvement Program generated hospital leadership buy-in toward implementing best OUD care practices. Factors at the hospital-level that influenced implementation success included supporting interdisciplinary OUD care champions, addressing knowledge gaps and biases around patients with OUD, having data systems that capture OUD care and integrate clinical protocols, incorporating patient comorbidities and non-medical needs into care, and fostering community provider linkages and capacity for warm handoffs. Although themes were largely consistent among hospital and staff types, protocol implementation was tailored by each hospital's size, patient volume, and hospital and community resources. CONCLUSIONS By understanding frontline staff's perspectives around factors that impact OUD care practices in the ED, stakeholders may better optimize implementation efforts.
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Affiliation(s)
- Esita Patel
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America.
| | - Keisha Solomon
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Haneefa Saleem
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Brendan Saloner
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Tracy Pugh
- Vital Strategies, New York City, NY, United States of America
| | - Eric Hulsey
- Vital Strategies, New York City, NY, United States of America
| | - Elli Leontsini
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
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King CA, Englander H, Korthuis PT, Barocas JA, McConnell KJ, Morris CD, Cook R. Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality. PLoS One 2021; 16:e0256793. [PMID: 34506517 PMCID: PMC8432751 DOI: 10.1371/journal.pone.0256793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 08/16/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Addiction consult services (ACS) engage hospitalized patients with opioid use disorder (OUD) in care and help meet their goals for substance use treatment. Little is known about how ACS affect mortality for patients with OUD. The objective of this study was to design and validate a model that estimates the impact of ACS care on 12-month mortality among hospitalized patients with OUD. METHODS We developed a Markov model of referral to an ACS, post-discharge engagement in SUD care, and 12-month drug-related and non-drug related mortality among hospitalized patients with OUD. We populated our model using Oregon Medicaid data and validated it using international modeling standards. RESULTS There were 6,654 patients with OUD hospitalized from April 2015 through December 2017. There were 114 (1.7%) drug-related deaths and 408 (6.1%) non-drug related deaths at 12 months. Bayesian logistic regression models estimated four percent (4%, 95% CI = 2%, 6%) of patients were referred to an ACS. Of those, 47% (95% CI = 37%, 57%) engaged in post-discharge OUD care, versus 20% not referred to an ACS (95% CI = 16%, 24%). The risk of drug-related death at 12 months among patients in post-discharge OUD care was 3% (95% CI = 0%, 7%) versus 6% not in care (95% CI = 2%, 10%). The risk of non-drug related death was 7% (95% CI = 1%, 13%) among patients in post-discharge OUD treatment, versus 9% not in care (95% CI = 5%, 13%). We validated our model by evaluating its predictive, external, internal, face and cross validity. DISCUSSION Our novel Markov model reflects trajectories of care and survival for patients hospitalized with OUD. This model can be used to evaluate the impact of other clinical and policy changes to improve patient survival.
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Affiliation(s)
- Caroline A. King
- Dept. of Biomedical Engineering, School of Medicine, Oregon Health & Science University, Portland, OR, United States of America
| | - Honora Englander
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, United States of America
| | - P. Todd Korthuis
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, United States of America
| | - Joshua A. Barocas
- Section of Infectious Diseases, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States of America
| | - K. John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, United States of America
| | - Cynthia D. Morris
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States of America
| | - Ryan Cook
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, United States of America
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Sikka MK, Gore S, Vega T, Strnad L, Gregg J, Englander H. "OPTIONS-DC", a feasible discharge planning conference to expand infection treatment options for people with substance use disorder. BMC Infect Dis 2021; 21:772. [PMID: 34372776 PMCID: PMC8351414 DOI: 10.1186/s12879-021-06514-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Serious bacterial infections associated with substance use often result in long hospitalizations, premature discharges, and high costs. Out-of-hospital treatment options in people with substance use disorder (SUD) are often limited. Methods We describe a novel multidisciplinary and interprofessional care conference, “OPTIONS-DC,” to identify treatment options agreeable to both patients and providers using the frameworks of harm reduction and patient-centered care. We retrospectively reviewed charts of patients who had an OPTIONS-DC between February 2018 and July 2019 and used content analysis to understand the conferences’ effects on antibiotic treatment options. Results Fifty patients had an OPTIONS-DC during the study window. Forty-two (84%) had some intravenous (IV) substance use and 44 (88%) had an active substance use disorder. Participants’ primary substances included opioids (65%) or methamphetamines (28%). On average, conferences lasted 28 min. OPTIONS-DC providers recommended out-of-hospital antibiotic treatment options for 34 (68%) of patients. OPTIONS-DC recommended first line therapy of IV antibiotics for 35 (70%) patients, long-acting injectable antibiotics for 14 (28%), and oral therapy for 1 (2%). 35 (70%) patients that had an OPTIONS-DC completed an antibiotic course and 6 (12%) left the hospital prematurely. OPTIONS-DC expanded treatment options by exposing and contextualizing SUD, psychosocial risk and protective factors; incorporating patient preferences; and allowing providers to tailor antibiotic and SUD recommendations. Conclusions OPTIONS-DC is a feasible intervention that allows providers to integrate principles of harm reduction and offer patient-centered choices among patients needing prolonged antibiotic treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06514-9.
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Affiliation(s)
- Monica K Sikka
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L457, Portland, OR, 97239-3098, USA.
| | - Sara Gore
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L457, Portland, OR, 97239-3098, USA
| | - Taylor Vega
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Luke Strnad
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L457, Portland, OR, 97239-3098, USA.,Epidemiology Programs, School of Public Health, Oregon Health and Science University and Portland State University, Portland, OR, USA
| | - Jessica Gregg
- Section of Addiction Medicine, Division of General Internal Medicine, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, BTE 119, Portland, OR, 97239-3098, USA.,Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Honora Englander
- Section of Addiction Medicine, Division of General Internal Medicine, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, BTE 119, Portland, OR, 97239-3098, USA. .,Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
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25
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Vega TA, Levander XA, Seaman A, Korthuis PT, Englander H. "Sobriety equals getting rid of hepatitis C": A qualitative study exploring the interplay of substance use disorder and hepatitis C among hospitalized adults. J Subst Abuse Treat 2021; 127:108337. [PMID: 34134860 PMCID: PMC8217723 DOI: 10.1016/j.jsat.2021.108337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 12/18/2020] [Accepted: 02/15/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND People who use drugs (PWUD) commonly experience complex illness, psychosocial stressors, housing insecurity, and stigma, which may play key roles in their struggles with addiction. In a study of hospitalized PWUD with hepatitis C virus infection (HCV), participants described treating HCV as "part of recovery." These findings led us to explore how hospitalization and acute illness altered patients' perceptions of substance use disorder (SUD) and HCV. METHODS Researchers audio recorded in-depth semi-structured individual interviews of 27 hospitalized adults with SUD and HCV seen by an addiction consult service (ACS) at an urban academic medical center between June and November 2019. Research staff transcribed interviews and dual coded them deductively and inductively at the semantic level. Researchers used a matrix visualization to discern relationships among codes and conducted a thematic analysis. RESULTS Many participants believed addictions treatment should precede an HCV cure for varying reasons. Some wanted to avoid reinfection; others believed "getting clean" afforded the mental clarity to address health issues, including HCV. Patients newly engaged in SUD treatment described HCV treatment as a "step towards recovery" and could serve as motivation to continue SUD treatment. Participants believed HCV cure could facilitate sobriety by "mentally putting drugs in the past" and was a future-oriented action toward "better health." Many participants described the compounded stigma of having HCV infection and SUD by multiple groups, including friends/family who do not use drugs, other drug users, and health care workers. CONCLUSION Hospitalized adults with SUD and HCV believed addictions engagement should precede HCV treatment and HCV cure could play an important role in their "recovery" journey. Discussing HCV treatment during hospitalization may be an opportunity to support engagement in SUD treatment and targets an untreated patient population critical for achieving HCV elimination.
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Affiliation(s)
- Taylor A Vega
- School of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States.
| | - Ximena A Levander
- Department of Medicine, Division of General Internal Medicine, Section of Addiction Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States.
| | - Andrew Seaman
- Department of Medicine, Division of General Internal Medicine, Section of Addiction Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States; Central City Concern, 232 NW6th Ave., Portland, OR 97209, United States.
| | - P Todd Korthuis
- Department of Medicine, Division of General Internal Medicine, Section of Addiction Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States.
| | - Honora Englander
- Department of Medicine, Division of Hospital Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States.
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26
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Utilising an access to care integrated framework to explore the perceptions of hepatitis C treatment of hospital-based interventions among people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103356. [PMID: 34226111 DOI: 10.1016/j.drugpo.2021.103356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Gaps remain in the hepatitis C virus (HCV) care cascade for people who use drugs (PWUD). Acute medical or surgical illnesses requiring hospitalisation are an opportunity to address addiction, but how inpatient strategies could affect HCV care accessibility for PWUD remains unknown. We explored patient perspectives of hospital-based interventions using an integrated framework of access to HCV care. METHODS We conducted a qualitative study of hospitalised adults (n=27) with HCV and addiction admitted to an urban academic medical centre in the United States between June and November 2019. Individual interviews were audio-recorded, transcribed, and dual-coded. We analysed data with coding specific for hospital-based interventions including screening, conducting HCV-related laboratory work-up, starting treatment, connecting with peers, and coordinating outpatient care. We analysed coded data at the semantic level for emergent themes using a framework approach based off an integrated framework of access to HCV care. RESULTS The majority of participants primarily used opioids (78%), were white (85%) and men (67%). Participants frequently reported HCV screening during previous hospitalisation with rare inpatient connection to HCV-related services. Participants expressed willingness to discuss HCV treatment candidacy during hospitalisation; however, lack of inpatient conversations led to perception that "nothing could be done" during admission. Participants expressed interest in completing inpatient HCV work-up to "get the ball rollin'" - consolidating care would enhance outpatient service permeability by reducing barriers. Others resisted HCV care coordination, preferring to focus on "immediate" issues including health conditions and addiction treatment. Participants also expressed openness to engaging with peers about HCV, noting shared drug use experience as critical to a peer relationship when discussing HCV. CONCLUSION Hospitalised PWUD have varied priorities, necessitating adaptable interventions for addressing HCV. Hospitalisation can be an opportunity to address HCV access to care including identification of treatment eligibility, consolidation of care, and facilitation of HCV-related referrals.
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27
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Gryczynski J, Nordeck CD, Welsh C, Mitchell SG, O'Grady KE, Schwartz RP. Preventing Hospital Readmission for Patients With Comorbid Substance Use Disorder : A Randomized Trial. Ann Intern Med 2021; 174:899-909. [PMID: 33819055 DOI: 10.7326/m20-5475] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hospitalized patients with comorbid substance use disorders (SUDs) are at high risk for poor outcomes, including readmission and emergency department (ED) use. OBJECTIVE To determine whether patient navigation services reduce hospital readmissions. DESIGN Randomized controlled trial comparing Navigation Services to Avoid Rehospitalization (NavSTAR) versus treatment as usual (TAU). (ClinicalTrials.gov: NCT02599818). SETTING Urban academic hospital in Baltimore, Maryland, with an SUD consultation service. PARTICIPANTS 400 hospitalized adults with comorbid SUD (opioid, cocaine, or alcohol). INTERVENTION NavSTAR used proactive case management, advocacy, service linkage, and motivational support to resolve internal and external barriers to care and address SUD, medical, and basic needs for 3 months after discharge. MEASUREMENTS Data on inpatient readmissions (primary outcome) and ED visits for 12 months were obtained for all participants via the regional health information exchange. Entry into SUD treatment, substance use, and related outcomes were assessed at 3-, 6-, and 12-month follow-up. RESULTS Participants had high levels of acute care use: 69% had an inpatient readmission and 79% visited the ED over the 12-month observation period. Event rates per 1000 person-days were 6.05 (NavSTAR) versus 8.13 (TAU) for inpatient admissions (hazard ratio, 0.74 [95% CI, 0.58 to 0.96]; P = 0.020) and 17.66 (NavSTAR) versus 27.85 (TAU) for ED visits (hazard ratio, 0.66 [CI, 0.49 to 0.89]; P = 0.006). Participants in the NavSTAR group were less likely to have an inpatient readmission within 30 days than those receiving TAU (15.5% vs. 30.0%; P < 0.001) and were more likely to enter community SUD treatment after discharge (P = 0.014; treatment entry within 3 months, 50.3% NavSTAR vs. 35.3% TAU). LIMITATION Single-site trial, which limits generalizability. CONCLUSION Patient navigation reduced inpatient readmissions and ED visits in this clinically challenging sample of hospitalized patients with comorbid SUDs. PRIMARY FUNDING SOURCE National Institute on Drug Abuse.
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Affiliation(s)
- Jan Gryczynski
- Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.)
| | - Courtney D Nordeck
- Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.)
| | - Christopher Welsh
- University of Maryland School of Medicine, Baltimore, Maryland (C.W.)
| | - Shannon G Mitchell
- Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.)
| | | | - Robert P Schwartz
- Friends Research Institute, Baltimore, Maryland (J.G., C.D.N., S.G.M., R.P.S.)
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Lennox R, Lamarche L, O'Shea T. Peer support workers as a bridge: a qualitative study exploring the role of peer support workers in the care of people who use drugs during and after hospitalization. Harm Reduct J 2021; 18:19. [PMID: 33593364 PMCID: PMC7885412 DOI: 10.1186/s12954-021-00467-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To describe the key qualities and unique roles of peer support workers in the care of people who inject drugs during and after hospitalization. METHODS We conducted a qualitative study. Key stakeholders were recruited including: people who use drugs who had been hospitalized, healthcare team members, peer support workers, and employers of peer support workers. Data were collected from 2019 to 2020 using semi-structured interviews that were audio-recorded, transcribed, and analyzed thematically. RESULTS Fourteen participants were interviewed: 6 people who use drugs who had been hospitalized, 5 healthcare team members, 2 peer support workers, and 1 employer of peer support workers. At the core of the data was the notion of peer workers acting as a bridge. We found four themes that related to functions of this bridge: overcoming system barriers, advocacy, navigating transitions within the healthcare system, and restoring trust between HCPs and PWUD. We found two themes for building a strong bridge and making the role of a peer support worker function effectively (training and mentorship, and establishing boundaries). We found three themes involving characteristics of an effective peer worker (intrinsic qualities, contributions of shared experiences, and personal stability). CONCLUSION Peer support workers are highly valued by both people who use drugs and members of the healthcare team. Peer support workers act as a bridge between patients and healthcare providers and are critical in establishing trust, easing transitions in care, and providing unique supports to people who use drugs during and after hospitalization.
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Affiliation(s)
- Robin Lennox
- Department of Family Medicine, McMaster University, Hamilton, Canada.
| | - Larkin Lamarche
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Tim O'Shea
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Canada
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Faherty LJ, Hadland SE, Stein BD, Patrick SW. Multiplying the Impact of Opioid Settlement Funds by Investing in Primary Prevention. J Hosp Med 2020; 15:625-627. [PMID: 32853139 PMCID: PMC7531941 DOI: 10.12788/jhm.3455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/30/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Laura J Faherty
- RAND Corporation, Boston, Massachusetts
- School of Medicine, Boston University, Boston, Massachusetts
- Corresponding Author: Laura J Faherty, MD, MPH, MS; ; Telephone: 617-338-2059 x8693; Twitter: @LauraFahertyMD
| | - Scott E Hadland
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Division of General Pediatrics, Department of Pediatrics, Boston University, Boston, Massachusetts
| | - Bradley D Stein
- RAND Corporation, Pittsburgh, Pennsylvania
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen W Patrick
- RAND Corporation, Pittsburgh, Pennsylvania
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
- Mildred Stahlman Division of Neonatology, Vanderbilt University, Nashville, Tennessee
- Vanderbilt Center for Child Health Policy, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee
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Englander H, Priest KC, Snyder H, Martin M, Calcaterra S, Gregg J. A Call to Action: Hospitalists' Role in Addressing Substance Use Disorder. J Hosp Med 2020; 15:184-187. [PMID: 31634100 PMCID: PMC7064302 DOI: 10.12788/jhm.3311] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 01/24/2023]
Affiliation(s)
- Honora Englander
- Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon
- Corresponding Author: Honora Englander, MD; E-mail: ; Telephone: 503-494-1164; Twitter: @honoraenglander
| | - Kelsey C Priest
- School of Medicine, MD/PhD Program, Oregon Health & Science University, Portland, Oregon
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
| | - Hannah Snyder
- Department of Family Medicine, University of California, San Francisco, California
| | - Marlene Martin
- Division of Hospital Medicine, Zuckerberg San Francisco General Hospital and the Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Susan Calcaterra
- University of Colorado, Department of Medicine, Division of General Internal Medicine and Division of Hospital Medicine, Denver, Colorado
| | - Jessica Gregg
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon
- Division of General Internal Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon
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Collins D, Alla J, Nicolaidis C, Gregg J, Gullickson DJ, Patten A, Englander H. "If It Wasn't for Him, I Wouldn't Have Talked to Them": Qualitative Study of Addiction Peer Mentorship in the Hospital. J Gen Intern Med 2019:10.1007/s11606-019-05311-0. [PMID: 31512181 DOI: 10.1007/s11606-019-05311-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hospitalizations related to substance use disorders (SUD) are skyrocketing. Hospital providers commonly feel unprepared to care for patients with SUD and patients with SUD commonly feel discriminated against by hospital staff. This tension can lead to provider burnout and poor patient outcomes. Research in ambulatory settings suggests that peer mentors (PMs) can improve substance use outcomes and patient experience. However, no study has examined the role of peer mentorship for patients with SUD in hospitals. OBJECTIVE Understand how peer mentorship affects care for hospitalized patients with SUD, and how working in a hospital affects PMs' sense of professional identity. DESIGN Qualitative study utilizing participant observation, individual interviews, and focus groups related to the PM component of the Improving Addiction Care Team (IMPACT), a hospital-based interprofessional addiction medicine consult service. PARTICIPANTS IMPACT providers, patients seen by IMPACT, PMs, and a PM supervisor. APPROACH Qualitative thematic analysis. KEY RESULTS PMs occupy a unique space in the hospital and are able to form meaningful relationships with hospitalized patients based on trust and shared lived experiences. PMs facilitate patient care by contextualizing patient experiences to teams and providers. Reciprocally, PMs "translate" provider recommendations to patients in ways that patients can hear. Respondents described PMs as "cultural brokers" who have the potential to transfer trust that they have earned with patients to providers and systems who may otherwise be viewed as untrustworthy. While PMs felt their role led to professional and personal development, the intensity of the role in the hospital setting also put them at risk for emotional drain and stress. CONCLUSIONS While integrating PMs into hospital care presents substantial challenges, PMs may act as a "secret weapon" to engage often marginalized hospitalized patients with SUD and improve patient and provider experience.
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Affiliation(s)
- Devin Collins
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Juliet Alla
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Christina Nicolaidis
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- School of Social Work, Portland State University, Portland, OR, USA
| | - Jessica Gregg
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Alisa Patten
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Honora Englander
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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Englander H, Dobbertin K, Lind BK, Nicolaidis C, Graven P, Dorfman C, Korthuis PT. Inpatient Addiction Medicine Consultation and Post-Hospital Substance Use Disorder Treatment Engagement: a Propensity-Matched Analysis. J Gen Intern Med 2019; 34:2796-2803. [PMID: 31410816 PMCID: PMC6854181 DOI: 10.1007/s11606-019-05251-9] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Hospitalizations due to medical and surgical complications of substance use disorder (SUD) are rising. Most hospitals lack systems to treat SUD, and most people with SUD do not engage in treatment after discharge. OBJECTIVE Determine the effect of a hospital-based addiction medicine consult service, the Improving Addiction Care Team (IMPACT), on post-hospital SUD treatment engagement. DESIGN Cohort study using multivariable analysis of Oregon Medicaid claims comparing IMPACT patients with propensity-matched controls. PARTICIPANTS 18-64-year-old Oregon Medicaid beneficiaries with SUD, hospitalized at an Oregon hospital between July 1, 2015, and September 30, 2016. IMPACT patients (n = 208) were matched to controls (n = 416) using a propensity score that accounted for SUD, gender, age, race, residence region, and diagnoses. INTERVENTIONS IMPACT included hospital-based consultation care from an interdisciplinary team of addiction medicine physicians, social workers, and peers with lived experience in recovery. IMPACT met patients during hospitalization; offered pharmacotherapy, behavioral treatments, and harm reduction services; and supported linkages to SUD treatment after discharge. OUTCOMES Healthcare Effectiveness Data and Information Set (HEDIS) measure of SUD treatment engagement, defined as two or more claims on two separate days for SUD care within 34 days of discharge. RESULTS Only 17.2% of all patients were engaged in SUD treatment before hospitalization. IMPACT patients engaged in SUD treatment following discharge more frequently than controls (38.9% vs. 23.3%, p < 0.01; aOR 2.15, 95% confidence interval [CI] 1.29-3.58). IMPACT participation remained associated with SUD treatment engagement when limiting the sample to people who were not engaged in treatment prior to hospitalization (aOR 2.63; 95% CI 1.46-4.72). CONCLUSIONS Hospital-based addiction medicine consultation can improve SUD treatment engagement, which is associated with reduced substance use, mortality, and other important clinical outcomes. National expansion of such models represents an opportunity to address an enduring gap in the SUD treatment continuum.
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Affiliation(s)
- Honora Englander
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Konrad Dobbertin
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, USA
| | - Bonnie K Lind
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, USA
| | - Christina Nicolaidis
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA.,Portland State University School of Social Work, Portland, OR, USA
| | - Peter Graven
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Claire Dorfman
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - P Todd Korthuis
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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